Sunday, July 26, 2009

Bill Moyers sits down with Trudy Lieberman, director of the health and medical reporting program at the CUNY Graduate School of Journalism, and Marcia Angell, senior lecturer in social medicine at Harvard Medical School and former editor in chief of the New England Journal of Medicine.

MARCIA ANGELL: For whatever price they want to charge. Right. And so, this will increase costs. And let me tell you what he's running into, and he'd like to be able to pull a rabbit out of the hat, but he won't be able to. If you leave this profit-oriented system in place, you can't both control costs and increase coverage. You inevitably, if you try to increase coverage, increase costs. The only answer, the only answer, and he said it at the beginning of his press conference, is a single payer system. In his first sentence, he said, that is the only way to cover everyone.

BILL MOYERS: But he's also said, if we were starting the system from scratch, we could have single payer. But we're not starting this system from scratch.

MARCIA ANGELL: You know, you don't pour more money into a failing system. You convert.

BILL MOYERS: I saw back in the spring-- the chief lobbyist for the Big Pharma industry, Billy Tauzin, used to be a member of Congress. He was on CNBC. And he was in support of this bill, whatever this bill is. Because it would broaden the industry's customer base by providing subsidies for people to buy--

MARCIA ANGELL: Exactly.

BILL MOYERS: Do you believe the health care industry when it tells President Obama that "we will voluntarily cut costs"?

MARCIA ANGELL: No. I mean, these are investor owned businesses. If they behave like charities, heads would roll in the executive suites. They are there to maximize profits. And that's exactly what they do.

TRUDY LIEBERMAN: What's happened now is that the industries have gotten pretty much what they want out of the bills that are going forward.

And so, they need to build public support. They need to make everybody in the public realize that they actually are wearing white hats in this one. But behind the scenes, they are lobbying ferociously against the public plan, against cuts in doctors fees, against all kinds of things that they don't want. And for that they're using a different sort of lobbying tactic. All of these are communications or lobbying strategies that they know how to do and they are very excellent at doing them.

MARCIA ANGELL: It's clear that they can turn it to their advantage.

TRUDY LIEBERMAN: Right.

MARCIA ANGELL: That nobody is really trying to break their-- except the single payer people -- their death grip on the system. And here you have hundreds of for profit insurance companies that maximize their income by denying care to the people who need it most. And that's the insurance system. That's how we pay for health care.

But you also have to look at how we deliver health care. And we deliver that, primarily or largely, in for-profit facilities -- businesses, hospitals -- whose interest is in delivering only profitable care. So, we have a system that's through and through, in both the payment system and the delivery system, is oriented toward profits. Neither the Senate nor the House is doing anything to change that.

BILL MOYERS: The President says there will be a public option in my bill that will compete with the private insurance. To bring the cost down.

TRUDY LIEBERMAN: That's--

BILL MOYERS: That's what he said.

TRUDY LIEBERMAN: That's what he says. Again, we get back to the detail question and the particulars, which are so absent in this whole discussion. We don't know what a public plan will look like. And even if there's going to be a public plan. The insurers don't want it. It's not clear that the doctors want it. And the pharmaceutical companies don't want it.

So my question is, are they working behind the scenes to make sure this doesn't happen? My guess is-- my answer is, they probably are.

MARCIA ANGELL: A lot is said about how the public wants to cling to what it has. What I'm finding is something that confirms the polls that have been done. Showing that something like two-thirds of the public would favor a Canadian style or a Medicare for all style single payer system.

The same is true of physicians, now. About 60 percent of physicians favor Medicare for all, or a single payer system. So, what is against it? The pharmaceutical and the insurance industries are the biggest lobbies in Washington. They spend millions and millions on influential members of Congress. And the amount that they are spending now to the Chairman of the relevant health committees has increased enormously in the past few months.